Should Hospitals Embrace Letter Grades?

Several years ago, the Health Department of New York City started requiring restaurants to post letter grades summarizing their sanitary inspection scores. The aim was to inform the public about a restaurant’s sanitary conditions and reduce illnesses associated with dining out.

Before letter grades, restaurants were motivated to practice food safety of their own volition to maintain healthful conditions, and under the threat of penalties for violations found at the time of inspection. Letter grading introduced a potentially more significant incentive: public recognition of a restaurant’s quality.

Since the start of the grading program, restaurant sanitary practices have improved citywide due to the increased transparency of information provided to the public. Within a year of the program's launch, cases of a common food-borne bacterium in city restaurants dropped to its lowest levels in 20 years. The Health Department expects sanitary conditions to continue to improve because, in addition to more frequent inspections to monitor and educate restaurant operators, an “A” grade serves as powerful incentive for restaurants to employ safer practices.¹

If the health care industry adopted objective grading for performance, there would be greater incentive for facilities to provide the highest quality of care. Increased transparency would also promote safer practices and improve outcomes for patients.

The health care industry should not only embrace this concept, but also mandate it across the nation to provide the public with greater access to inspection reports on the quality of care at different facilities.

Implementing such a grading system could achieve 3 goals:

• Inform the public about the inspection results of a health care facility to help prospective patients make more educated, individualized decisions related to their care
• Improve health care quality conditions and patient safety practices in facilities through increased transparency
• Teduce unfavorable health-related outcomes associated with medical treatment.

One of the best-applied examples of this concept is the Hospital Safety Score, which uses 28 national performance measures from several leading organizations in patient safety to produce a letter grade (A, B, C, D, F, or NS) that indicates a hospital’s overall performance in keeping patients safe from preventable harm and medical errors.²

This simple, objective score encompasses a plethora of research and allows the public to make informed decisions regarding medical care with greater ease. The transparency that comes from public reporting should compel hospitals to be more open about their safety and quality.

If New Yorkers have the right to know the health score of a restaurant where they will eat, then patient should have the right to know the health score of a facility where they will potentially receive life-saving medical treatment.

References:

• Restaurant Grading in New York City at 18 Months. NYC Department of Health. http://www.nyc.gov/html/doh/downloads/pdf/rii/restaurant-grading-18-month-report.pdf

• How Safe is Your Hospital? The Leap Frog Group. http://www.hospitalsafetyscore.org/